Yesterday we commented on the common misdiagnosis of Lewy Body Disease, a problem often mistaken for Alzheimer's Disease. In keeping with that theme, we look today at results from an international physician survey on Alzheimer's diagnoses.
Based on a survey of nearly a thousand physicians in five countries (USA, Japan, UK, France, and Italy), we are not doing a very good job at diagnosing Alzheimer's disease in clinical practice. In fact, about half of all physicians agreed that the disease is "often misdiagnosed" and that diagnoses are "always or often" made too late to treat in a meaningful way.
None of this is news to regular readers of this blog as late detection of cognitive impairment is one of our frequent themes. However, the survey revealed an interesting perspective from the physicians, in terms of "why" they feel diagnoses are so commonly late.
According to the physicians surveyed, the major contributing factors to late diagnosis are:
- lack of a definitive diagnostic test;
- lack of communication from patients/caregivers; and
- stigma
Not mentioned among their reasons is the one glaring problem that primary care physicians confess to me on a regular basis. I hear frequently from physicians that investigating memory complaints takes too much time, and often leads to a diagnosis of a problem they don't feel they can treat effectively. This perspective often leads them to "just keep an eye on the concern" until symptoms worsen and the need for medical intervention is clear. As the survey noted, this is "too late".
Managing the cognitive health of an aging population is a complex problem, and a difficult one to approach within the confines of our current "fee for service" healthcare system. As new models evolve, like the Accountable Care Organizations described in the Healthcare Reform Act, we will have an opportunity to greatly improve our standards of care in this important field.
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So, I think this entry might better be titled, "The delayed diagnosis of AD." Either way, you've identified a powerful dynamic at work in geriatric medicine today. Or should we say, in adult medicine, given that some symptoms appear in mid-life that are swept under the rug, both by patient & family, as well as medical care providers. Where we expect denial and minimization on the part of the patient, it is said indeed that that dynamic extends across to the providers as well.
ReplyDeleteunfortunately, if dementia is diagnosed there is almost nothing that can be done to treat the condition. The pills that are approved have lots of side effects, and if they do work they only work for 1 year tops in preventing the situation from worsening and then the decline resumes.
ReplyDeleteThe anonymous comment above is off track. Dementia is a state of impaired cognition with many causes, many of which are completely treatable, some of which (like Alzheimer's disease) are less so.
ReplyDeleteEven when Alzheimer's disease is the cause of the dementia, approved treatments are much more beneficial than most headlines indicate. I agree that "pills" alone, when started on a patient who is already demented (late stage Alzheimer's disease), the effect is moderate. However, a robust regimen of proper diet, physical exercise, and careful control of chronic conditions such as diabetes and hypertension, when combined with approved Alzheimer's medications, can significantly slow disease progression for a majority of patients.
My mother started showing signs of Alzheimer's in her 50's. She got her dianosis 12 years ago at the age of 61. Today she is about the equivalent of a newborn. She opens her mouth if you touch food to her lips, but does not speak, barely moves, and is just "not there." Most of the time, she does not even open her eyes. There is no recognition of anyone or anything.
ReplyDeleteThree years ago, her younger sister started showing signs of the disease, at 68. I urged her to let her doctor know my concern. Her doctor, whom my aunt puts way too much trust in, laughed it off and told her she was "sharp as a tack" and just "under a lot of stress." No memory test was given. I have watched my aunt decline over the last three years. I finally called her doctor's office myself, and demanded they conduct a memory test, which my aunt failed. Now this doctor will not send her to a neurologist, but instead just wants to treat her herself, since "nothing can really be done except to give her Aricept anyway." Have I mentioned that my aunt completely trusts this doctor? I am at my wits end because she doesn't even want us to change her diet or add coconut oil (which I have read good things about). I don't know what to do.
I am currently 59 years old and have been experiencing cognitive problems for the last ten years. My primary care provider would do bloodwork which never really never showed anything substantial. Both my parents have dementia which began in their seventies. For many years I went from doctor to doctor asking and hoping someone would find something wrong with me. In 1986 I was diagnosed with hypothyroidism and since then it has been downhill. In the past few years I have had a B12 deficiency, A vitamin D deficiency, confusion and memory problems. I am seeing a new physician and finally I feel hopeful. Sometimes you have to look outside of the Mainstream medicine to find the help you need. There are Doctors who think alternatively yet carry that Medical degree. They don't just hand you a prescription and send you on your way, they actually look for the cause. Don't give up! I actually am feeling better for the first time in many years.
ReplyDeleteIn spite of the fact that it is so common, Hospital Privacy Screens Alzheimer's disease often goes unrecognized or is misdiagnosed in its early stages. Many doctors and nurses, patients, and family members mistakenly view the early symptoms of Alzheimer's disease as the inevitable consequences of aging.
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